To advance reproductive justice, a strategy that confronts the intersectionality of race, ethnicity, and gender identity is critical. This article provides a detailed account of how divisions of health equity within obstetrics and gynecology departments can dismantle obstacles to advancement, thereby moving our field closer to optimal and equitable care for everyone. The community-based activities of these divisions, which were unique in their focus on education, clinical practice, research, and innovative approaches, were described.

Twin gestations frequently present an increased susceptibility to pregnancy-related problems. While the management of twin pregnancies requires careful consideration, the supporting data is often insufficient, which frequently leads to differences in recommendations amongst various national and international professional organizations. Clinical guidelines, though covering twin pregnancies, are frequently incomplete in their guidance regarding twin gestation management, which is more extensively covered in practice guidelines designed to address pregnancy complications like preterm birth, authored by the same professional body. A hurdle for care providers is the identification and comparison of recommendations for managing twin pregnancies. Examining the guidelines of several professional societies in high-income nations regarding twin pregnancy management was the objective of this study; this involved both summarizing and contrasting the recommendations to identify areas of consensus and dispute. The clinical practice guidelines of prominent professional organizations, either centered on twin pregnancies or encompassing pregnancy complications and aspects of antenatal care important for managing twin pregnancies, were examined. We proactively decided to integrate clinical guidelines from seven high-income countries—the United States, Canada, the United Kingdom, France, Germany, Australia, and New Zealand—and two international societies: the International Society of Ultrasound in Obstetrics and Gynecology and the International Federation of Gynecology and Obstetrics. Recommendations for first-trimester care, antenatal observation, preterm labor and other pregnancy issues (preeclampsia, fetal growth restriction, gestational diabetes mellitus), and the timing and method of delivery were established by us. Eleven professional societies, spanning seven countries and two international bodies, published 28 guidelines that we identified. Thirteen of these guidelines are devoted to the intricacies of twin pregnancies, while a further sixteen focus on the distinct complications associated with single pregnancies, still including pertinent recommendations for twin pregnancies in their scope. Among the guidelines, fifteen out of twenty-nine are distinctly recent publications, having emerged over the past three years. A notable divergence in guidelines was found, primarily within four specific areas: the screening and prevention of preterm birth, the use of aspirin in preventing preeclampsia, establishing definitions for fetal growth restriction, and determining the delivery schedule. In addition, constrained direction is present regarding numerous critical domains, encompassing the outcomes of the vanishing twin phenomenon, the technical intricacies and risks of invasive procedures, nutritional and weight management considerations, physical and sexual activity guidelines, the best growth chart for twin pregnancies, the diagnosis and care for gestational diabetes, and care during childbirth.

A definitive, universally accepted protocol for surgical management of pelvic organ prolapse is not present. Data from the past points to a geographical variation in the success of apical repairs across various US health systems. physical and rehabilitation medicine The absence of standardized treatment plans may account for this diversity in approaches. Differing hysterectomy strategies used in pelvic organ prolapse repair can have ramifications for complementary surgical interventions and healthcare system utilization.
This study's aim was to explore the geographic differences in surgical techniques for prolapse repair hysterectomy, encompassing both colporrhaphy and colpopexy procedures at a statewide level.
Between October 2015 and December 2021, a retrospective analysis was undertaken of fee-for-service insurance claims from Blue Cross Blue Shield, Medicare, and Medicaid in Michigan, focusing on hysterectomies performed for prolapse. Based on the International Classification of Diseases, Tenth Revision codes, prolapse was recognized. County-level variations in surgical approach for hysterectomies, as categorized by Current Procedural Terminology codes (vaginal, laparoscopic, laparoscopic-assisted vaginal, or abdominal), constituted the primary outcome measure. The county of residence of the patient was calculated based on the zip codes of their home address. A hierarchical model was used to analyze the impact of various factors on vaginal delivery, using a multivariable logistic regression, with county-level random effects being included. The fixed-effects model incorporated patient attributes, such as age, comorbidities (diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, morbid obesity), concurrent gynecologic diagnoses, health insurance type, and social vulnerability index. A median odds ratio was employed to measure the disparity in vaginal hysterectomy rates observed among different counties.
In 78 eligible counties, 6,974 hysterectomies were completed for the correction of prolapse. A vaginal hysterectomy was performed on 2865 (411%) of the cases, while laparoscopic assisted vaginal hysterectomy was performed on 1119 (160%) cases, and 2990 (429%) cases had laparoscopic hysterectomy. The percentage of vaginal hysterectomies, across a sample of 78 counties, varied dramatically, falling between 58% and a maximum of 868%. Variability is substantial, as evidenced by a median odds ratio of 186 (95% credible interval: 133-383). The observed vaginal hysterectomy proportions in thirty-seven counties were deemed statistical outliers because they fell outside the predicted range, as measured by the confidence intervals of the funnel plot. The study revealed that vaginal hysterectomy was correlated with a higher incidence of concurrent colporrhaphy compared to both laparoscopic assisted vaginal and open laparoscopic hysterectomy (885% vs 656% and 411%, respectively; P<.001), while it exhibited a lower prevalence of concurrent colpopexy procedures (457% vs 517% and 801%, respectively; P<.001).
This comprehensive statewide analysis demonstrates significant variability in the methods used for hysterectomies performed due to prolapse. The multitude of surgical techniques used in hysterectomy procedures might explain the wide disparity in concurrent procedures, especially those related to apical suspension. These data illustrate how the surgical options for uterine prolapse are geographically contingent.
This statewide study demonstrates a considerable divergence in the surgical methods used for hysterectomies conducted for prolapse. genetic perspective The multitude of surgical approaches to hysterectomy may explain the high rates of disparity in accompanying procedures, notably those relating to apical suspension. Surgical procedures for uterine prolapse can vary based on geographic location, as these data confirm.

Menopause, marked by a decrease in systemic estrogen, is a recognized contributor to the emergence of pelvic floor disorders, including prolapse, urinary incontinence, overactive bladder, and the distressing symptoms of vulvovaginal atrophy. Studies from the past indicate that intravaginal estrogen therapy before surgery might be helpful for postmenopausal women suffering from prolapse symptoms, but its impact on additional pelvic floor problems is still unclear.
A primary objective of this study was to quantify the impact of intravaginal estrogen, contrasted with placebo, on the symptomatology of stress and urge urinary incontinence, urinary frequency, sexual function, dyspareunia, and vaginal atrophy in postmenopausal women with symptomatic pelvic organ prolapse.
This planned ancillary analysis of a randomized, double-blind trial, “Investigation to Minimize Prolapse Recurrence Of the Vagina using Estrogen,” involved participants with stage 2 apical and/or anterior prolapse, scheduled for transvaginal native tissue apical repair at three US sites. A regimen of 1 g conjugated estrogen intravaginal cream (0.625 mg/g) or a corresponding placebo (11) was administered intravaginally, nightly for the initial two weeks and twice weekly for the subsequent five weeks before surgery, and then continued twice weekly for an entire year postoperatively. Comparing participant responses from baseline and preoperative visits, this analysis considered lower urinary tract symptoms (Urogenital Distress Inventory-6 Questionnaire), questions related to sexual health, specifically dyspareunia (Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire-IUGA-Revised), and symptoms of atrophy (dryness, soreness, dyspareunia, discharge, and itching), which were each scored on a scale of 1 to 4, with 4 being the highest level of bother. Masked examiners assessed vaginal color, dryness, and petechiae, each characteristic graded on a scale from 1 to 3. The combined score ranged from 3 to 9, 9 being the maximum score for the most estrogen-influenced appearance. The analysis of the data was conducted following an intent-to-treat model and a per-protocol design, considering participants who adhered to at least 50% of the prescribed intravaginal cream, determined through objective evaluation of tube usage before and after weight measurements.
Among the 199 participants who were randomized (with a mean age of 65 years) and provided baseline data, 191 possessed preoperative information. The groups displayed comparable attributes. learn more The Total Urogenital Distress Inventory-6 (TUDI-6) scores, monitored for seven weeks between baseline and pre-operative visits, did not show significant changes. Specifically, in patients with moderately or worse baseline stress urinary incontinence (32 in the estrogen group and 21 in the placebo group), improvement was noted in 16 (50%) of the estrogen group and 9 (43%) of the placebo group. This improvement was not deemed statistically meaningful (P = .78).